Contraception 101

Many women think that they don't have to worry about contraception while they are breastfeeding.  Under perfect conditions, a mother who is exclusively breastfeeding has a 2% chance of conceiving in the first 6 months postpartum.  This percentage has the potential to increase with the ups and downs of being a new parent.  While breastfeeding can prevent menstruation, it is not uncommon for ovulation to occur prior to the return of your period.  Using an additional method of birth control, can provide the much-desired protection.

Barrier methods such as condoms, contraceptive sponges, diaphragms and cervical caps are all reliable options.  Almost all patients can use these methods but they need to be used each and every time to make them effective.  Over the course of a year, a woman using condoms as her only method of birth control risks a 15% chance of pregnancy.  While condoms and sponges can be purchased over the counter, diaphragms and cervical caps require a prescription from your physician.  Diaphragms require fitting and should be checked after giving birth to ensure a good fit.

The one contraceptive method most women are familiar with is birth control pills.  While combined (both estrogen and progesterone) oral contraceptive pills (OCPs) are generally considered safe, women with certain medical conditions should not take them.  It is recommended to wait 6 weeks after birth before starting this method to decrease the risk of blood clot formation.  For breastfeeding moms, estrogen and progesterone have been found in breast milk. Estrogen seems to suppress lactation while progesterone does not have this effect. Therefore, women who are exclusively breastfeeding should utilize another method of contraception. One alternative to combined OCPs is the progesterone only pill a.k.a. the mini pill.  Compared to OCPs, the mini pill is prone to more breakthrough bleeding and a slight increase in the pregnancy rate.  It is a reasonable option for moms who are exclusively breastfeeding and for some women who cannot take OCPs. 

If you are considering waiting more than a year or two to conceive, there are contraceptive methods which do not require your daily attention.  All long acting methods are considered safe during lactation with no impact on milk production.  Intrauterine devices (IUDs) are one option. This includes the copper containing ParaGard, good for 10 years, and the progesterone containing Mirena, good for 5 years.   ParaGard is a hormone-free option that almost all patients can utilize.  One common side effect is heavier menstrual periods.  Mirena's hormonal effect is mostly localized to the endometrial lining which provides lighter periods over time.  In the first 6 months of use, some patients will experience spotting between periods.  By one year, 20% of women will no longer get their periods.  Both devices can be inserted in your doctor's office.  While there is an initial cost up front for some patients, these methods tend to pay for themselves if used for at least two years. 

Additional methods include injectable progesterone such as Depo-Provera which is effective for 3 months at time.  It can be associated with weight gain, mood swings and breakthrough bleeding, and there can be a delay of fertility up to a year after discontinuing this method. Implanon/Nexplanon is a small rod which is inserted in the arm in your doctor's office.  It is effective for 3 years.  Unlike previous implantables, the new implants are easier to remove and insert. As with all progesterone methods, there is the risk of breakthrough bleeding and weight gain.  

Permanent methods of birth control include tubal ligation, transcervical tubal obstruction, and vasectomy.  Tubal ligation can be performed at the time of cesarean section, immediately postpartum or laparoscopically. Essure and Adiana are two methods for blocking the tubes transcervically.  All of these methods require thoughtful consideration and should be considered irreversible. 

A visit with your doctor can help provide additional information in finding the perfect method of contraception for you and your family. 

Nicole Siems, D.O. practices at Princeton OB/GYN where she sees to the health of many new moms.  For more information or to schedule an appointment please call 609.683.9292 or visit www.princetonobgyn.com.